Cytoreductive drugs (CRT)

Cytoreductive drugs represent a broad therapeutic category of agents designed to reduce the total number of cells in the body, primarily used in the management of myeloproliferative neoplasms (MPNs) and other hematologic malignancies [2, 9]. This class is not a single molecular target but rather a group of medications with diverse mechanisms of action, including the inhibition of DNA synthesis by hydroxyurea, DNA cross-linking by alkylating agents like busulfan, and the modulation of cytokine signaling by interferons [12, 14]. Their primary biological function is to control the hyperproliferation of hematopoietic cells, which helps prevent life-threatening complications such as thrombosis, hemorrhage, and progressive splenomegaly [3, 13]. In clinical oncology and hematology, the selection of a specific cytoreductive agent is tailored to the patient's risk stratification, age, and the presence of specific molecular drivers like the JAK2 V617F mutation [5, 11]. Despite their efficacy in controlling blood counts, these drugs carry significant safety risks, most notably profound bone marrow suppression and a potential long-term risk of secondary leukemic transformation [12, 14].

Other names

Cytoreductive therapyCytoreductive agentsMyelosuppressive agentsMyelosuppressive therapy

Cytoreductive drugs act through diverse mechanisms to reduce the total cell mass: hydroxyurea inhibits ribonucleotide reductase to deplete deoxyribonucleotide pools and halt DNA synthesis [9, 14]; alkylating agents like busulfan cross-link DNA strands to induce cell death [12, 14]; biological response modifiers like interferons activate the IFNAR receptor to modulate gene expression and inhibit progenitor cell growth [1, 14]; and targeted inhibitors like ruxolitinib block overactive JAK-STAT signaling pathways [5, 12].